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Sagittal T2

Anterior inferior corner fracture of the C6 vertebral body with extension into the intervertebral disc space and severe anterior widening of the C6/C7 intervertebral disc space consistent with hyperextension fracture. Subtle high T2 signal in the right superior articular process of the right C7 corresponds to a nondisplaced fracture visualized on CT. The anterior longitudinal ligament is disrupted at the level of the fracture with a small anterior prevertebral haematoma extending to the level of C2 superiorly. There is exaggerated angulation at C6/C7 at the level of the fracture with moderate canal stenosis and obliteration of the CSF space surrounding the cord. No evidence of epidural haematoma, or intrinsic cord signal abnormality to suggest oedema or cord contusion.

Annotated

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Hyperextension fracture of the anteroinferior corner of C6 with extension into the intervertebral disc, traumatic intervertebral disc injury and disruption of anterior longitudinal ligament.

Case Discussion

This case demonstrates the typical radiographic features found in extension tear-drop fractures of the lower cervical spine. As its name suggests, this type of fracture is produced by forced extension of the neck. There is resulting avulsion of the fibers of the anterior longitudinal ligament off the anteroinferior endplate of the vertebral body. The shape of the avulsed fragment is triangular, with the vertical dimension being equal to, or larger than the transverse dimension.

Whilst a standard x-ray may demonstrate the character of the avulsed fragment and/or soft tissue shadowing associated with this fracture (indicative of pre-vertebral soft tissue swelling), CT is often required to better characterize the fracture and to evaluate for additional injuries. MR imaging is often performed to determine the extent of ligamentous disruption and the presence/extent of spinal cord edema, contusion and/or injury.

Treatment of this type of fracture depends on fragment size, displacement or angulation, intervertebral disc injury, spinal stability and/or neurological deficit(s). This patient was managed conservatively in a hard C-spine collar due to complications from his MSSA septicemia.